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Heroin Addiction and Related Clinical Problems: 2016, 18, 2 (pages: 21 - 24)

Illicit and over-the-counter codeine dependence after acute back pain—successful treatment and ongoing recovery after buprenorphine/naloxone taper

Kean J.

Summary: Increased prescribing of opioids for pain has been associated with an increase in dependency and associated morbidity and mortality. There are no evidence-based guidelines to direct the treatment of prescription or over-the-counter codeine dependency, including the use of maintenance and tapered dosing, or its use in conjunction with psychosocial interventions (PSI). Here we report the case of a family man who developed opioid analgesic dependence after being prescribed opioids for acute back pain. After his repeat prescription was stopped, he sourced both illicit and over-the-counter codeine. After 4 years of escalating use to a daily codeine dose of 1250 mg, he presented to a substance misuse service, The Bridge Project, Bradford. After successful induction and stabilisation on buprenorphine/naloxone (8 mg/2 mg) over the course of one week, our client successfully tapered over a 4-month period. He remained in work during treatment, and experienced side effects that were limited to headaches and some depressive thoughts. Opioid substitution treatment—buprenorphine/naloxone within a holistic Change Programme that included structured behavioural change psychosocial interventions—was successful, supporting slow taper across a 4-month period conducted within Unity Recovery Centre, part of the Bridge Project.